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Tuesday, March 8, 2011

Top 10 Breastfeeding Misconceptions

Welcome to the March Carnival of Natural Parenting: Natural Parenting Top 10 Lists

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Code Name: Mama and Hobo Mama. This month our participantshave shared Top 10 lists on a wide variety of aspects of attachmentparenting and natural living. Please read to the end to find a list oflinks to the other carnival participants.

Then you have the baby, and you have a few struggles, so you do some research. You find out all kinds of information, so much stuff you wish you'd known sooner! And the next thing you know, you're so brimful of knowledge that every time someone says something ignorant about breastfeeding you are just dying to speak up.

However, when what people are saying is, "I wanted so badly to nurse my baby, but it didn't work out," you don't exactly want to come back with, "Actually, you could have, had you had the benefit of my amazing knowledge." So I tend not to reply ... but I store up these stories in my head so that I can share with people who have not yet had these problems, and my answers might do some good.

Without further ado, here are 10 things people say about breastfeeding that are not always true.

1. My baby never wanted to nurse.

All babies want to nurse. The question is, what is stopping the baby from being able to nurse? There are so many reasons. A healthy baby, placed skin-to-skin with mom immediately after birth, will usually nurse on his own within the hour. But if the baby is separated for some reason, he might not want to nurse immediately when he comes back. You may have to wait till he's awake and hungry. To help get things moving, you can put baby skin-to-skin (meaning naked on your bare chest) and let him nurse when he is ready. Check his rooting reflex by stroking his cheek. He'll turn in that direction and open his mouth. That means he wants to nurse!

Sometimes a baby might not want to nurse at birth because of discomfort. If he's been suctioned (like mine was) or if his jaw was hurt in the birth, it might take longer as well. Try to be patient, and see if you can get help.

2. I wanted to breastfeed, but my milk never came in.

My question is, how do you know it never came in? Were you nursing frequently? Did the baby's diapers turn from green and brown to yellow? Then your milk came in. Not everyone gets engorged when their milk comes in. If you're in doubt, express a little and look at the color. Colostrum is yellow; real milk is white. Transitional milk can be anywhere in between.

Some women don't have their milk come in as quickly as others. It may be delayed as much as a week due to some medications, having an IV during labor, or even no reason at all. Keep feeding the baby colostrum, supplement if necessary (preferably under the supervision of a lactation consultant or knowledgeable doctor) and be patient.

3. I knew I didn't have enough milk because my baby never burped.

Burping has nothing to do with having enough to eat, and everything to do with swallowing air. If a baby has a good latch, he might not burp at all. That's not a problem -- just one less thing for you to worry about!

4. My milk disappeared at six weeks.

This is another misconception caused by the "engorgement = milk" myth. During the first six weeks, most women have an oversupply. But around six weeks, the supply starts to regulate. Is the baby still producing enough diapers? Is he happy after nursing or screaming? He may nurse a lot at six weeks old because of a growth spurt -- but if he's just switching from side to side, nursing all day long, but happy and wetting regularly, he's getting enough.

5. My baby preferred the bottle/a binky to me.

This is not so much a "preference" as nipple confusion. A baby sucks differently at a breast, a bottle, and a pacifier. An exclusively breastfed baby can even vary his sucking based on what he wants -- deep sucking for hunger, and shallow sucking for comfort.

That shallow suck does not keep a pacifier in, so if a baby is always given a pacifier, he'll learn to suck deeply for comfort as well. And then you get a baby who can't comfort nurse, because he sucks hard and keeps getting milk. So frustrating! So he ends up with the binky, and chances are milk supply begins to decrease, baby starts getting hungry a lot, and you end up mixing up a bottle of formula. Then the baby "prefers" the bottle too, and next thing you know, you've weaned. Pacifiers and bottles may be introduced later (say around four weeks or older), but even so, they sometimes do cause confusion. Things only went really well for us once we lost the binky.

6. I didn't have enough milk -- I could only pump an ounce!

Some women respond very well to a pump, and some don't. The pump may get an ounce out while your baby gets six ounces. Lactation consultants often determine how much milk you are producing by weighing the baby, having you nurse him, then weighing again. That's the only reliable method to find out what he's getting.

Now, sometimes it's vital to be able to get out more milk with the pump. In these cases, it's helpful to have a slight oversupply. Some people have success with herbs like fenugreek or medications like domperidone. Others will find the secret to success is nursing a lot when they are with their baby -- at night, especially. Many moms will not be able to produce enough while exclusively pumping, which is why it's so vital to get the baby latching right from the get-go. If you do have to pump exclusively, be aware that it's going to be difficult. Some are successful and some aren't -- so don't beat yourself up if it doesn't work.

7. It was incredibly painful -- and his latch was perfect!

A baby's latch may appear "perfect" from the outside, but if he's not sucking properly, it will hurt like the dickens. When Marko has a stuffy nose, he can't suck well, so he tries biting. Not so nice! One common reason for a bad suck is tongue tie. There are many kinds of tongue tie and some are hard to detect -- so if you are experiencing pain, have him looked over by someone familiar with tongue tie. A tie can be clipped by an ear, nose, and throat doctor; it is not usually more than a pinch for the baby. And the difference can be dramatic!

Other suck problems may be caused by an injury to the jaw during birth -- a chiropractor or physical therapist can help you with that. Others just require practice. I've heard of "training" a baby to suck by having him suck your finger -- ask your lactation consultant.

The last reason that breastfeeding can be very painful is inverted or flat nipples. There's no cure for this one, but the pain will go away after a week or two. Other than that, nursing is NOT supposed to be painful, especially not very painful. Please see someone who can help you if you are experiencing pain!

8. I should not have had problems with nipple confusion, because I used a special "breast-like" bottle.

Sadly, there's no bottle that can imitate the breast. It might be a similar shape, but it will never require the serious sucking that a breast does. I've heard drinking out of a bottle compared to trying to do a beer bong! The milk just drips out, whether baby works for it or not. The baby might still want to nurse, but not remember how to suck, or that he'll have to suck for a few minutes before the milk appears. Don't introduce bottles before four weeks at the earliest!

9. I should not have had problems when I put my baby on a three-hour schedule. My sister did it and it worked fine for her.

Women have a different storage capacity for milk. Your sister might be able to hold three hours' worth of milk, while you can only hold two hours' worth. So if you feed your baby every three hours, he gets two hours' worth of milk every three hours. That's a recipe for disaster! Soon you will stop producing as much milk, because your body thinks it isn't needed. And the baby will stop gaining weight, or even lose weight. He may become dehydrated or fail to thrive. Please do not use these strict schedules -- feed your baby when he is hungry!

10. My baby self-weaned very suddenly at nine months.

Weaning is not usually sudden, and very rarely (if ever) do children wean themselves before the second year. Self-weaning happens when a toddler slowly reduces his nursing sessions, dropping them one by one. A sudden halt in all nursing is more likely a nursing strike. The baby loses interest in nursing for awhile, because of a new distraction like solid food. But he still needs milk. You can take the opportunity to wean to a sippy cup of formula if you want to, but otherwise, keep offering the breast, especially when he's sleepy. You may need to pump to keep up supply. A baby might stop nursing for a week or more and then come back to the breast! So if you wanted to nurse longer, don't despair just because of a temporary disinterest.

None of this is to say that there aren't real reasons why women can't breastfeed. Some really don't have enough milk. This is less common than people think, but it does happen. If you suspect low milk supply, watch wet diapers and weight gain carefully. Others don't breastfeed for myriad reasons -- incompatible medication, sickness, a medical crisis after birth, psychological discomfort, and so forth. Others could have overcome their difficulties in a perfect world, but didn't have the support to do so. Some women are devastated that they couldn't nurse. So it's important to be accepting and really listen to people's stories, instead of giving a ton of facts. This list is intended more to help other moms before they wean.

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21 comments:

Great post. I think a lot of women don't realize just how often a normal baby nurses (b/c we are part of a bottlefeeding culture and even the "exclusively breastfed" babies are not being nursed NEARLY as much as they are in traditional cultures) and that may contribute to a lot of the misconceptions you listed. Also a lot of women keep their kids in a crib so it is a LOT more disruptive to get up and nurse as often as they need to during the night.

Great list! Spend about ten minutes in a La Leche League meeting and you will likely hear all of these. One more to add: nursing is only beneficial for little babies/if they can ask, they are too old. Mama's milk is important for toddlers, too!

Sarah -- that bottlefeeding culture is the downfall of a lot of people! I was lucky enough to be raised in a breastfeeding family, with young siblings when I was a teenager, so all of my experience is with breastfed babies. It really helped once I had my own!

Fidelio -- wow, how unusual! Mine is slowly stepping down on the amount he nurses, so it wouldn't surprise me if he weaned on the earlier side, but so far it's quite gradual. He's had some nursing strikes before, as you may remember, so I hope I would recognize the difference. When I want him to wean, I'll just stop offering -- my guess is he won't nurse all that long after that. If I didn't remind him, he wouldn't nurse half as often as he does.

Brittany, I have been lucky enough never to hear that one! My siblings each nursed a nice long time, so it's normal for me. But I do hear that people think such a preposterous notion. I suppose I could always point them to the Bible, the book of Maccabees: "I bore you for nine months, nursed you for three years, and raised you," etc. It's only in our modern age that we're more comfortable with seeing toddlers sucking pacifiers and carrying around bottles than with seeing them nurse. I blame that old bottle-feeding culture for that one!

It's so hard to say how much pain is normal with breastfeeding... I didn't have any major problems and we had a pretty good latch but even so it still hurt like the dickens for the first 30 seconds of every nursing session in the first week after my eldest was born.

I stuck it out and it got better quickly, but I think a little discomfort at the beginning is pretty normal. Knowing when a little normal discomfort crosses over into pain that indicates a problem is the hard part.

I remember reading somewhere that if it continues hurting after the initial latch then something is wrong, so if I got to that point I'd break the suction with my finger and try latching again. It was a pretty good strategy.

Enbrethiel -- chances are, you were getting sleepy at that point. Many babies are only wide awake for about an hour after birth before wanting to sleep for as much as 12 hours! I know mine had no interest whatever in nursing till about 12 hours after he was born ... up to then he was too sleepy, and probably had a sore throat from the suctioning they gave him as well.

Michelle -- the information I was given at the hospital said it shouldn't be toe-curlingly painful after the first few seconds, which sounds fair to me. It would be hard for me to say, because we DID have latch problems that are probably responsible for any pain I had. In any event, if it hurts throughout the whole nursing session, or if it's still hurting at all after two weeks, there is almost certainly a problem somewhere.

Wow, this list touched on many of the problems that I had in the beginning. First, I made sure she didn't have a pacifier during the hospital stay. My milk came in very late. The complications due to my c-section didn't help matters (needing a blood transfusion.) One good thing that came out of it was that I had access to nurses and specialists for 4 nights. Although they also made it more difficult because they made me supplement with formula and a syringe taped to my breasts. I'm not looking forward to that part of having a baby, again. By the time we brought her home, she was a latching-pro, but I do remember the cluster feeding at night drove me crazy. By day 6, I had to give her about 0.5 ounces formula from a bottle. I hated it, but it was the only way she and I could get any sleep. I continued to breastfeed every three hours, or earlier, before I gave her a bottle. That worked for us, for quite a while, until I went to my 7-week check up with my OB. She prescribed me some medication, also used for anti-nausea. It doesn't work immediately, but as soon as the medication ran out, I could breastfeed exclusively! No bottles! After that it was smooth sailing. I continued to breastfeed until a week after she turned 18 months old. Another thing that I wanted to mention was about pumping. I couldn't pump anything. I could count how many times I was engorged on my hand. Most mothers do need to rely on pumping when they go back to work. Luckily I returned to work when she was six months, part-time, so she survived well without one feeding at night. A lot of young mothers (on Facebook, particularly) think that they need to pump every 10 minutes or whatever to increase their supply. I also heard that during the breastfeeding class I attended. But the reality was that all my Facebook friends who did this, didn't last three months breastfeeding their babies. What do you think of that pumping theory? Sure, it must help, but I suppose since I didn't enjoy pumping I didn't like that option.

Personally, I think an overemphasis on pumping as the solution to all problems is the end of a lot of breastfeeding relationships, because everyone hates doing it. And when are you supposed to find the time to pump in between caring for a new baby? Pretty soon what was supposed to be fairly pleasant, or at least not complicated, is a grueling chore with all that pumping thrown in. It's much better to take medication or herbs to increase supply, or to take the baby to bed for a nice long "nursing vacation" where you do nothing but nurse that baby for awhile. If you're always pumping and clock-watching, it's no wonder that you're dying to quit.

I personally loathe pumping and have hardly ever done it. Makes me feel like a cow. I have so much respect for people who do it on a regular basis, because that would be such a sacrifice.

#3. My breastfed baby never burped, so I totally agree! I think excess air coming in is more common with bottles.

#5. We avoided pacifiers out of fear of nipple confusion, but I don't think I knew that about the comfort sucking/deep sucking confusion — that makes so much sense.

#6. Ugh, I hated pumping, too. So much work for so little reward! I'm glad I knew not to count what my baby was getting nursing by what I was getting from pumping. (I pumped at first due to bad hospital advice that had Mikko supplementing for a week, and then later on to donate.)

#10. My mom always says my brother self-weaned at 6 months, and I always bite my tongue because I imagine it was probably a nursing strike rather than true weaning at that age. I'm 38 years too late, in any case! :)

"I wanted so badly to nurse my baby, but it didn't work out," you don't exactly want to come back with, "Actually, you could have, had you had the benefit of my amazing knowledge."

Haha! I have the same problem of being unsure how to proceed when it comes to sharing the massive amount of info stored in my brain. I don't want to come across as being holier than thou and make them feel ignorant or guilty about their choices but I want to help them by sharing what I know. Nobody likes unwanted advice either. It is socially awkward at times. Great article though! I'll link people to it so they can educate themselves. Perhaps that is the most tactful way.

Wolfmother -- yeah, I'm always in a position of "to give advice, or not?" A friend of mine recently posted baby pictures of their baby in the hospital with a pacifier. I knew they intended to breastfeed so I commented, "If you want an easier time nursing, you'd probably better lose the paci," and then told why. Then I felt like a nosey, interfering person. Luckily the dad didn't mind, and told me the nurses had given it to the baby without asking, but that the baby didn't like it so they took it out. So that one was a success. Not every time I open my mouth, trying to be helpful, is a success though.

It's just so rough, knowing what to say when people need help. That's part of why I blog so much advice -- I would like new parents to happen across this info BEFORE they need it. Or at the very least, I could send a link instead of starting in on a lecture. One time, someone decided not to circumcise their son based on a link I sent -- that sure was a good feeling!